Interventions for preventing distal intestinal obstruction syndrome (DIOS) in cystic fibrosis
Appendices
Appendix 1. Search strategies
| Database/Resource | Strategy |
| Cochrane Central Register of Controlled Trials (CENTRAL) | #1 Cystic Fibrosis [MeSH descriptor] #2 cystic fibrosis:ti,ab #3 fibrocystic near/10 disease near/10 pancreas #4 mucoviscidos*:ti,ab #5 cystic* near/10 fibros*:ti,ab #6 #1 or #2 or #3 or #4 or #5 #7 distal intestinal obstruction syndrome*:ti,ab #8 dios or mie:ti,ab #9 Intestinal Obstruction [MeSH descriptor] #10 meconium ileus equivalent:ti,ab #11 faecal near/3 (obstruction or impact*):ti,ab #12 Constipation [MeSH descriptor] #13 constipat*:ti,ab #14 laxative*:ti,ab #15 Laxatives [MeSH descriptor] #16 lactulose:ti,ab #17 Lactulose [MeSH descriptor] #18 (macrogol or polyethylene glycol*):ti,ab #19 Polyethylene Glycols [MeSH descriptor] #20 movicol:ti,ab #21 klean*:ti,ab #22 diatriozate:ti,ab #23 gastrografin:ti,ab #24 senna:ti,ab #25 docusate:ti,ab #26 picosulfate:ti,ab #27 acetylcysteine or fibrol:ti,ab #28 parvolex:ti,ab #29 fibre:ti,ab #30 picosulphate:ti,ab #31 #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17 or #18 or #19 or #20 or #21 or #22 or #23 or #24 or #25 or #26 or #27 or #28 or #29 #30 #32 #6 and #31 |
| MEDLINE Ovid (1946 onwards) | 1. Cystic Fibrosis/ 2. cystic fibrosis.tw. 3. (fibrocystic adj10 disease adj10 pancreas).tw. 4. mucoviscidos$.tw. 5. (cystic$ adj10 fibros$).tw. 6. 1 or 2 or 3 or 4 or 5 7. "distal intestinal obstruction syndrome*".tw. 8. (dios or mie).tw. 9. Intestinal Obstruction/ 10. meconium ileus equivalent.tw. 11. (faecal adj3 (obstruction or impact*)).tw. 12. Constipation/ 13. "constipat*".tw. 14. "laxative*".tw. 15. Laxatives/ 16. lactulose.tw. or Lactulose/ 17. (macrogol or polyethylene glycol*).tw. or Polyethylene Glycols/ 18. movicol.tw. 19. klean*.tw. 20. diatriozate.tw. 21. gastrografin.tw. 22. senna.tw. 23. docusate.tw. 24. bicosulfate.tw. 25. acetylcysteine or fibrol.tw. 26. parvolex.tw. 27. fibre.tw. 28. picosulphate.tw. 29. 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 30. 6 and 29 |
| Embase Ovid (1974 onwards) | 1. CYSTIC FIBROSIS/ 2. cystic fibrosis.tw. 3. (fibrocystic adj10 disease adj10 pancreas).tw. 4. mucoviscidos$.tw. 5. (cystic$ adj10 fibros$).tw. 6. 1 or 2 or 3 or 4 or 5 7. "distal intestinal obstruction syndrome*".tw. 8. (dios or mie).tw. 9. INTESTINE OBSTRUCTION/ 10. meconium ileus equivalent.tw. 11. (faecal adj3 (obstruction or impact*)).tw. 12. CONSTIPATION/ 13. "constipat*".tw. 14. "laxative*".tw. 15. LAXATIVE/ 16. lactulose.tw. or LACTULOSE/ 17. (macrogol or polyethylene glycol*).mp,hw. 18. movicol.tw. 19. klean*.tw. 20. diatriozate.tw. 21. gastrografin.tw. 22. senna.tw. 23. docusate.tw. 24. bicosulfate.tw. 25. acetylcysteine or fibrol.tw. 26. parvolex.tw. 27. fibre.tw. 28. picosulphate.tw. 29. 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 30. 6 and 29 |
| Clinicaltrials.gov | ADVANCED SEARCH Search 1 Search 2 |
| ISRCTN Registry | ADVANCED SEARCH Condition: cystic fibrosis |
| WHO ICTRP | BASIC SEARCHES Search 1: cystic fibrosis AND intestinal Search 2: cystic fibrosis AND constipation Search 3: cystic fibrosis AND faecal Search 4: cystic fibrosis AND meconium Search 5: mucoviscidose ADVANCED SEARCH Intervention: laxative OR laxatives OR lactulose OR macrogol OR polyethylene OR movicol OR klean OR diatriozate OR gastrografin OR senna OR docusate OR bicosulfate OR acetylcysteine OR fibrol OR parvolex OR picosulphate OR fibre Recruitment Status: All |
| Open Grey | (cystic fibrosis OR cf OR mucoviscidos*) AND (intestin* OR constipat* OR faecal OR meconium OR laxative* OR lactulose OR macrogol OR polyethylene OR movicol OR klean* OR diatriozate OR gastrografin OR senna OR docusate OR bicosulfate OR acetylcysteine OR fibrol OR parvolex OR picosulphate OR fibre) |
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1 Cisapride versus placebo, Outcome 1 Total gastrointestinal symptoms.
Comparison 1 Cisapride versus placebo, Outcome 2 Abdominal pain.
Comparison 1 Cisapride versus placebo, Outcome 3 Abdominal distension.
| Cisapride compared to placebo for preventing distal intestinal obstruction syndrome (DIOS) in cystic fibrosis | ||||||
| Patient or population: preventing DIOS in cystic fibrosis | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Certainty of the evidence | Comments | |
| Risk with placebo | Risk with cisapride | |||||
| Radiological diagnosis of DIOS (physician‐measured radiological scores) Follow‐up: baseline to 6 months | Trial investigators stated that there was no significant difference between cisapride and placebo. | NA | 17 | ⊕⊝⊝⊝ | Radiologist scored for radiographic signs of DIOS, no numerical data available. | |
| Adverse effects (participant interviews) Follow‐up: 3 to 12 months | No adverse effects were noted in either group. | NA | 17 | ⊕⊝⊝⊝ | No numerical data available. | |
| Total gastrointestinal symptom scores (participant‐reported symptom scores from 20 to 100) Follow‐up: 3 to 12 months | The mean difference was 7.6 lower in the cisapride arm | NA | 17 | ⊕⊝⊝⊝ | Score made up of 10 different gastrointestinal symptoms: heartburn, flatulence, regurgitation, fullness, abdominal distension, abdominal pain, diarrhoea, nausea, vomiting, anorexia. | |
| Hospitalisation for any cause | Outcome not reported. | NA | NA | |||
| Hospitalisation for DIOS | Outcome not reported. | NA | NA | |||
| Quality of life | Outcome not reported. | NA | NA | |||
| Tolerability | Outcome not reported. | NA | NA | |||
| *The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1. Selective reporting may have occurred with this outcome; allocation concealment and sequence generation was unclear. 2. Cisapride is a prokinetic, not a typical laxative agent (different to protocol). The study was conducted in 1990 when cisapride was still prescribed. It has now been taken off the UK market and other international markets due to its rare but serious cardiac effects. 3. Very small number of participants in the trial does not give sufficient information to give a precise effect estimate. 4. Allocation concealment and sequence generation ranked as unclear risk of bias. | ||||||
| Intervention | Total number of participants | Felt better | Felt the same | Felt worse |
| Cisapride | 17 | 12 | 2 | 3 |
| Placebo | 17 | 3 | 2 | 12 |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Total gastrointestinal symptoms Show forest plot | 1 | Mean Difference (Fixed, 95% CI) | Totals not selected | |
| 1.1 At 6 months | 1 | Mean Difference (Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 2 Abdominal pain Show forest plot | 1 | Mean Difference (Fixed, 95% CI) | Totals not selected | |
| 2.1 At 6 months | 1 | Mean Difference (Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 3 Abdominal distension Show forest plot | 1 | Mean Difference (Fixed, 95% CI) | Totals not selected | |
| 3.1 At 6 months | 1 | Mean Difference (Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
